However, it is important to determine how including a control condition and their specific nature impacts the efficacy results of CBT in anxiety disorders. Furthermore, one important question is how results derived from research studies in mostly well-controlled research designs (efficacy) generalize to real-world Angiogenesis inhibitor settings in naturalistic surroundings (effectiveness). Therefore, this review will particularly focus on two recent meta-analyses by Hofmann6 and by Stewart11regarding CBT treatment for panic disorder, generalized anxiety

disorder, social anxiety disorder, obsessive-compulsive Inhibitors,research,lifescience,medical disorder, and post-traumatic stress disorder. The first meta-analysis6 limited the included studies to randomized placebo-controlled trials, the gold standard in clinical outcome research. For example, the Federal Drug Administration Inhibitors,research,lifescience,medical (FDA) in the United States and the European Medicines Agency (EMA) require successful randomized placebo-controlled double-blind trials in order to approve Inhibitors,research,lifescience,medical a new medication. Pharmacotherapy trials typically administer a sugar pill to individuals in the placebo condition. Instead of including a pill placebo, a number of psychotherapy trials have employed psychological placebo conditions to control for nonspecific factors. To be included

in the meta-analysis,6 the psychological placebo had to involve interventions to control for nonspecific factors (eg, regular contact with a therapist, reasonable rationale for the intervention, discussions of the psychological problem). Although it is almost impossible to protect Inhibitors,research,lifescience,medical the blind in placebo-controlled

psychotherapy trials, the randomized placebo-controlled design is still the most rigorous and conservative test of the effects of an active treatment. Inhibitors,research,lifescience,medical This approach assesses the overall efficacy of CBT in anxiety disorders under well-controlled research conditions. Overall, 27 studies met inclusion criteria: n=7 for social anxiety disorder, n=6 for post-traumatic stress disorder, n=5 for panic disorder, n=4 for acute stress disorder, n=3 for obsessive-compulsive disorder, and n=2 for generalized anxiety disorder. As a controlled Carnitine palmitoyltransferase II effect size, Hedges’ g was calculated, which is a variation of Cohen’s d taking into account small sample sizes. In contrast to well-controlled efficacy studies in research settings, effectiveness studies examine how efficacious interventions are transferred into naturalistic real-world settings. Research treatments might not work equally well in clinical practice settings because of greater disease severity, or more comorbid conditions in patients in general practice compared with patients in research settings. Another variable that might impact the outcome in naturalistic settings is the treatments themselves and the clinicians who provide them.